Ji Zixiang, Wang Zhenyu, Li Hao
Department of General Surgery, Affiliated Hospital of Yanbian University, Yanji, P.R. China.
SAGE Open Med Case Rep. 2022 Jul 16;10:2050313X221110994. doi: 10.1177/2050313X221110994. eCollection 2022.
Abscess of the ligamentum teres hepatis has been described in the medical literature as an extremely rare clinical entity, which often presents a diagnostic dilemma. A 68-year-old man was hospitalized for upper abdominal pain and obstructive jaundice. The patient presented with low-grade intermittent fever. Laboratory investigations showed a white blood cell count of 32.38 × 10/L, a C-reactive protein level of 247.86 mg/L, abnormal liver enzyme and bilirubin levels, and elevated serum levels of amylase and lipase. He was first diagnosed with acute biliary pancreatitis. A computational tomography scan and magnetic resonance cholangiopancreatography revealed obstructive choledocholithiasis and cholecystolithiasis. The patient received preoperative antibiotics and symptomatic treatments for 5 days, followed by endoscopic retrograde cholangiopancreatography and a subsequent duodenal papilla incision to extract pigment and cholesterol gallstones. The patient recovered and was discharged on the fifth day after surgery. However, 10 days later, the patient was readmitted for the recurrence of acute calculous cholecystitis. Laboratory tests showed increases in total and direct bilirubin, γ-glutamyltransferase, and alkaline phosphatase, but not inflammatory parameters. After the patient's nutritional status improved on the 11th day after admission, a laparoscopic cholecystectomy was performed. Intraoperative exploration revealed extensive abdominal adhesions; a thickened edematous gallbladder wall; and an unexpected abscess of the ligamentum teres hepatis. Pus aspiration was performed laparoscopically after laparoscopic cholecystectomy, and to ensure elimination of the abscess, ultrasound-guided pus aspiration was also performed 1 week later. Fortunately, the patient made an uneventful recovery and was discharged with a drain tube on the 16th day after surgery. Doppler ultrasound indicated that the abscess had completely disappeared 2 weeks after discharge. This case highlights an unusual presentation of a ligamentum teres hepatis abscess caused by obstructive cholangitis but that appeared after the choledocholithiasis was resolved. However, the mechanism of abscess formation remained uncertain.
肝圆韧带脓肿在医学文献中被描述为一种极其罕见的临床病症，常带来诊断难题。一名68岁男性因上腹部疼痛和梗阻性黄疸入院。患者伴有低热、间歇性发热。实验室检查显示白细胞计数为32.38×10⁹/L，C反应蛋白水平为247.86mg/L，肝酶和胆红素水平异常，血清淀粉酶和脂肪酶水平升高。他最初被诊断为急性胆源性胰腺炎。计算机断层扫描和磁共振胰胆管造影显示存在梗阻性胆总管结石和胆囊结石。患者接受了5天的术前抗生素及对症治疗，随后进行了内镜逆行胰胆管造影及十二指肠乳头切开术以取出色素性和胆固醇性胆结石。患者术后恢复良好，于术后第5天出院。然而，10天后，患者因急性结石性胆囊炎复发再次入院。实验室检查显示总胆红素、直接胆红素、γ-谷氨酰转移酶和碱性磷酸酶升高，但炎症指标未升高。入院第11天患者营养状况改善后，进行了腹腔镜胆囊切除术。术中探查发现广泛的腹腔粘连、胆囊壁增厚水肿，以及意外的肝圆韧带脓肿。腹腔镜胆囊切除术后进行了腹腔镜下脓肿穿刺抽吸，为确保脓肿消除，1周后还进行了超声引导下脓肿穿刺抽吸。幸运的是，患者恢复顺利，术后第16天带引流管出院。出院2周后多普勒超声显示脓肿已完全消失。该病例突出了由梗阻性胆管炎引起但在胆总管结石解决后才出现的肝圆韧带脓肿的不寻常表现。然而，脓肿形成的机制仍不确定。
